2型糖尿病和代谢功能障碍相关脂肪变性肝病患者肝纤维化的非侵入性评估

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology Pub Date : 2025-09-01 DOI:10.1016/j.aohep.2025.102020

Laís Siqueira Maia , Luisa Lara Calazans , Luana Luna de Castro , Filipe Giordano Valerio , David Ramos Pinho , Igor Ishakewitsch Henrique Silva , Tamires Nascimento Dos Santos , Luis Guillermo Coca Velarde , João Marcello De Araújo-Neto , María Auxiliadora Nogueira Saad , Débora Soares Vieira , Priscila Pollo-Flores

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引用次数: 0

摘要

代谢功能障碍相关脂肪变性肝病（MASLD）是全球最常见的慢性肝病，全球2型糖尿病（T2D）患者的患病率为55.5%。T2D和肥胖是显著影响MASLD自然史的心脏代谢危险因素，增加了纤维化进展、肝硬化和肝细胞癌的风险。非侵入性检查（NITs）被推荐用于纤维化筛查，可以帮助预测MASLD高危人群中肝脏相关结局的风险。评估无创检测肝纤维化的方法，并评估糖尿病和MASLD人群中肝纤维化与进展预测因子之间的关系。材料和方法前瞻性、横断面、观察性研究纳入了一家三级医院年龄在18-75岁的T2D患者。所有参与者均提供知情同意。采用超声和瞬时弹性成像对肝脂肪变性和肝纤维化进行无创评估。资料采用非参数Mann-Whitney或Wilcoxon检验，采用R进行分析，显著性水平为p <； 0.05。结果本研究纳入96例患者。其中62例（64.5%）患有脂肪性肝炎，29例（30.2%）有显著纤维化（F≥2），13例（13.5%）有晚期纤维化（F≥3）。γ -谷氨酰转移酶（GGT）是唯一与纤维化存在统计学显著相关的血清生物标志物（p = 0.00997）。结论：在我们的糖尿病研究人群中，通过弹性成像评估，最可靠的非侵入性纤维化预测指标是GGT水平升高。

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NON-INVASIVE ASSESSMENT OF LIVER FIBROSIS IN THE POPULATION WITH TYPE 2 DIABETES AND METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE

Introduction and Objectives

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease worldwide, with a global prevalence of 55,5% among patients with type 2 diabetes (T2D). T2D and obesity are the cardiometabolic risk factors that significantly influence the natural history of MASLD, increasing the risk of fibrosis progression, cirrhosis and hepatocellular carcinoma. Non-invasive tests (NITs) are recommended for fibrosis screening and can help predict the risk of liver-related outcomes in populations at risk for MASLD.

To evaluate the non-invasive tests for detecting liver fibrosis and to assess the association between liver fibrosis and progression predictors in the population with diabetes and MASLD.

Materials and Methods

Prospective, cross-sectional, observational study included adults aged 18-75 with T2D from a tertiary hospital. All participants provided informed consent. Noninvasive assessment of hepatic steatosis and fibrosis were performed using ultrassonography and transient elastography. Data were analyzed using R with the non-parametric Mann-Whitney or Wilcoxon tests, and a significance level of p < 0.05 was adopted.

Results

This study included 96 patients. Of these, 62 (64.5%) had steatohepatitis, 29 (30.2%) had significant fibrosis (F≥ 2) and 13 (13.5%) had advanced fibrosis (F≥ 3) as determined by elastography. Gamma-glutamyl transferase (GGT) was the only serum biomarker that showed a statistically significant correlation with the presence of fibrosis (p = 0.00997).

Conclusions

In our study population with diabetes, the most reliable non-invasive predictor of fibrosis, as assessed by elastography, was elevated GGT levels.

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来源期刊

Annals of hepatology 医学-胃肠肝病学

CiteScore

7.90

自引率

2.60%

发文量

183

审稿时长

4-8 weeks

期刊介绍： Annals of Hepatology publishes original research on the biology and diseases of the liver in both humans and experimental models. Contributions may be submitted as regular articles. The journal also publishes concise reviews of both basic and clinical topics.